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女人痛苦的性

作者:Amanda Oakley Fracp,皮肤科医生,新西兰汉密尔顿,2011年。由澳大利亚悉尼的妇科医生詹妮弗·布拉德福德博士进行了审查。


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女人痛苦的性— codes and concepts
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What is painfulsex?

Painful sex is also calleddyspareunia. Dyspareunia is defined aspersistent或者recurrentgenitalpain that occurs just before, during or after intercourse. There are two types of dyspareunia in women:

  • 入口(表面)肿瘤,在此处或内部感受到疼痛阴道
  • 深度(腹部)肿瘤,where the pain is felt in the abdomen.

全疾病困难is common and may cause considerable distress to women and their sexual partners. It may be caused by structural, infective andinflammatorydiseases of thevulva, vagina and internal organs.社会心理因素inevitably contribute to and result from, dyspareunia.

  • 可能会发生困难基本的, i.e. occurred with the first attempt at intercourse and ever since; or secondary, occurring later, having previously had no pain with intercourse.
  • Pain can occur on every attempt at intercourse or only on certain occasions or in certain situations.

Entry dyspareunia

最常见的外阴导致肤浅或进入性疾病的皮肤疾病包括:

全疾病困难associated with a dry vagina or阴道l(阴道炎) may be due to:

全疾病困难也可能是由以下方式造成的:

  • Malformation生殖器:狭窄的阴道,labialadhesion,阴道隔,处女膜不可造
  • Injury during childbirth, genital mutilation, injury or surgery
  • Any pain affecting the vestibule (if the cause is unknown, this is called前庭)
  • Any pain affecting the vulva (if the cause is unknown, this is called外阴痛)
  • Tense pelvic floor muscles and/or vaginismus (involuntary pelvicmuscle contractions在尝试性交中)
  • 低性欲与恐惧,焦虑和关系问题有关,包括性虐待。
  • Urinary tract infection
  • Interstitial膀胱炎(疼痛膀胱综合征)
  • 肠易激综合症,违反肠疼痛缓解
  • 神经系统reasons, such aspudendal神经夹带综合征.

深度疾病

深度疾病意味着腹部而不是阴道中感觉到的性痛苦。原因可能包括:

  • 最近怀孕/分娩
  • 恢复uterus(this refers to the position of the womb)
  • 子宫脱垂
  • Pelvic inflammatory disease or infection
  • 子宫内膜异位症
  • Ovariancysts
  • 子宫肌瘤
  • Bowel disease especially irritable bowel syndrome (IBS)
  • Lumbosacral关节炎
  • Adhesions following previous surgery or radiation
  • 生殖道癌。

如何诊断出疾病的原因?

正确的诊断需要对整个身体进行仔细的病史和临​​床检查,包括外部生殖器,以及医学专家(例如妇科医生,性健康医师或全科医生)或物理治疗师的骨盆检查。Colposcopy可以执行(这是使用放大倍率和明亮光的骨盆检查)。应仔细识别疼痛部位。检查下anaestheticmay be required if discomfort is too great to allow a normal internal examination.

Investigations may include:

  • 细菌和病毒拭子
  • 皮肤活检
  • Ultrasoundexamination
  • 影像学检查

在许多情况下,没有发现肢发症的物理原因,它被认为是疼痛综合征。

How is dyspareunia treated?

General

Intercourse should not be painful. It's important to feel relaxed before attempting intercourse. Foreplay leading to sexual excitement relaxes the pelvic muscles, widens the vagina and releases vaginal fluids. Use liberal amounts of water-based lubricants and apply these to the penis and vaginal opening. Penetration from behind or woman-on-top may be better tolerated.

  • Don't use scented bath oils or shower gels, soaps or douches.
  • Emollients帮助外阴干燥和水性润滑剂或保湿剂用于阴道干燥。

药物治疗

If a cause for the dyspareunia has been found, appropriate treatment should help.

  • 雌激素cream, pessaries or rings reduce hormone-associated vaginal dryness and are often prescribed to post-menopausal women.
  • 局部麻醉cream or凝胶可能允许无痛的穿透。
  • 三环类药物如阿米替林可以减轻疼痛。
  • 肉毒杆菌毒素已被用来放松hypertonicpelvic floor muscles (experimental).

An experienced pelvic floor physiotherapist can help in retraining the pelvic floor to relax using special exercises. Counselling or behavioural therapy is appropriate for some women or couples.

If vaginal intercourse remains painful, consider other sexual options including massage and mutual masturbation.

参考

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